Bullying: Under The Radar - An Anonymous Survey
1. Default Section
1
. You are:
You are:
Male
Female
2
. What is your age?
What is your age?
3
. Where did you attend school?
Where did you attend school?
City/Town:
State/Province:
Country:
4
. How old were you when you were first bullied?
How old were you when you were first bullied?
Age
Length of Time
5
. What kind(s) of bullying did you experience?
What kind(s) of bullying did you experience?
Physical
Verbal
Relational/Social
Cyber
Homophobic
Racial
Other (please specify)
6
. Did you tell anyone?
Did you tell anyone?
Yes
No
7
. If yes, who?
If yes, who?
Parent
Friend
Teacher
Relative
Other
8
. Did they help you?
Did they help you?
Yes
No
9
. Did anyone witness the bullying? (If no, skip to Q10.)
Did anyone witness the bullying? (If no, skip to Q10.)
Yes
No
10
. If yes, who?
If yes, who?
Teacher(s)
Student(s)
Other
11
. If yes, did they intervene?
If yes, did they intervene?
Yes
No
12
. Did it help?
Did it help?
Yes
No
13
. Did you change schools because of bullying?
Did you change schools because of bullying?
Yes
No
14
. Did you drop out?
Did you drop out?
Yes
No
15
. Have the effects of bullying influenced your life?
Have the effects of bullying influenced your life?
Negatively
Positively
16
. Do you wish you had done anything differently?
Do you wish you had done anything differently?
Yes
No
17
. Is there any advice, words of wisdom and/or lessons learned that you can share with kids who are being bullied now?
Is there any advice, words of wisdom and/or lessons learned that you can share with kids who are being bullied now?
We thank you for sharing your experience and contributing to helping others.
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